Treatment & Procedures

Colorectal cancer
screening saves lives in two important ways:
- By finding and removing precancerous polyps
before they become cancerous
- By detecting
the cancer early when it is most treatable

Both men and women should undergo
testing for the disease beginning at age 50.
People with a high risk for colorectal
cancer and those with a family history
should talk with their doctor about being
screened at an earlier age. A study by
leading cancer groups found that colorectal
cancer deaths have declined nearly five
percent (2002-2004), in part due to
prevention through screening and the removal
of precancerous polyps.

Screening
tests for colorectal cancer

Screening is
done on individuals who do not necessarily
have any signs or symptoms that may indicate
cancer. If symptoms exist, then diagnostic
workups are done rather than screening.
These are the tests recommended for
colorectal cancer screening and some general
pros and cons for each:- Stool blood
test (fecal occult blood test--FOBT)-
Flexible sigmoidoscopy (flex-sig)-
Colonoscopy- Barium enema with air
contrast- Virtual colonoscopy (CT
Colonography)

STOOL BLOOD TEST (FECAL
OCCULT BLOOD TEST--FOBT)

This test is
used to find small amounts of hidden
(occult) blood in the stool. A sample of
stool is tested for traces of blood. People
having this test will receive a kit with
instructions that explain how to take stool
samples at home. The kit is then sent to a
lab for testing. If the test is positive,
further tests will be done to pinpoint the
exact cause of the bleeding. A rectal exam
in the doctor's office may examine for
occult blood, but this is NOT considered
adequate for colorectal cancer screening.
The test should only be done with a
take-home kit.

A newer kind of stool
blood test is known as FIT (fecal
immunochemical test). It is like the FOBT,
perhaps even easier to do, and it gives
fewer false positive results.

PROS
- Simple- Cost-effective- Done at
home

CONS- Must be done yearly
- Least effective means of detecting cancer
- Viewed as unsanitary by some- Patient
must retrieve samples of stool from the
toilet bowl- All positive results MUST
BE EVALUATED WITH A COLONOSCOPY

FLEXIBLE SIGMOIDOSCOPY (FLEX-SIG)

A
sigmoidoscope is a slender, lighted tube
about the thickness of a finger. It is
placed into the lower part of the colon
through the rectum. This allows the
physician to look at the inside of the
rectum and lower part of the colon for
cancer or polyps. This exam only evaluates
about one third of the colon. The test is
often done without any sedation, so it can
be uncomfortable, but it should not be
painful. Before the test, you will need to
take an enema or other prep to clean out the
lower colon.

PROS- Quick -
usually a one to five minute exam- Does
not require a vigorous bowel prep- Does
not require sedation

CONS- Can
only examine the lower third of the colon.
The other two-thirds of the colon are not
examined- If polyps are found, the
patient MUST RETURN FOR A FULL COLONOSCOPY

COLONOSCOPY

Colonoscopy allows for a
complete evaluation of the colon and removal
of potentially precancerous polyps. It is
the only colorectal cancer screening tool
that is both diagnostic and therapeutic. A
complete bowel cleansing is required before
the exam. The procedure uses a colonoscope,
a tube with a light and video camera on the
end, which allows the doctor to see the
entire colon. If a polyp is found, the
doctor can remove it immediately. The polyp
is usually removed with small biopsy forceps
or loop of wire (snare) that is advanced
within a channel in the colonoscope. The
polyp is then sent to the pathology lab for
analysis. If anything else looks abnormal, a
biopsy might be done. To do this, biopsy
forceps are placed in the colonoscope and a
small piece of tissue is removed. The tissue
is sent to the lab for evaluation. This test
is generally done with sedation and is
well-tolerated. You will be given medicine
that is injected through a vein to make you
feel relaxed and sleepy.

PROS-
Examines the entire colon, making it the
most thorough method for evaluating the
colon and rectum- High detection rate
for polyps, including small polyps, and
ability to remove them immediately during
the procedure- Done with intravenous
sedation to assure comfort during the exam
- Given the "Gold Standard" rating above all
other screening options by: American Society
for Gastrointestinal Endoscopy (ASGE),
American Gastroenterological Association
(AGA), American College of Gastroenterology
(ACG), the American Cancer Society (ACS),
and the American College of Obstetricians
and Gynecologists (ACOG).

CONS-
Requires a complete bowel prep the night
before to cleanse the colon- Unexpected
events or complications are rare, but do
occur and may include:- Missing a lesion
- Making a tear in the lining of the colon,
which is called perforation Bleeding- A
bad reaction to the medication used for
sedation

BARIUM ENEMA WITH AIR
CONTRAST

A chalky substance, which shows
up on X-ray, is given as an enema. Air is
then pumped into the colon causing it to
expand. This allows X-ray films to take
pictures of the colon. Laxatives must be
used the night before the exam to clean the
colon.

PROS- Done without
sedation- Very low risk

CONS-
Uses X-ray radiation- Can miss larger
polyps and growths (over 50 percent polyps
≤1 cm, and 15 percent of cancers)- If
polyps are found, the patient MUST BE
FOLLOWED UP WITH A COLONOSCOPY

CT
COLONOGRAPHY (also referred to as virtual
colonoscopy)

A small tube is placed in
the rectum and air is pumped into the colon
to inflate the bowel. Then a special CT scan
is used to image the colon. Recent studies
show that it is effective in identifying
medium to large polyps, but is ineffective
in identifying small polyps and it may also
miss flat polyps. CT colonography may be
best for low-risk patients who cannot
undergo or who failed a conventional
colonoscopy. The same bowel prep as
conventional colonoscopy is required and it
does not use sedation.

PROS-
Examines the entire colon- High
detection rate for medium to large polyps
- Low risk

CONS- Air distention
of the bowel can be uncomfortable-
Ineffective in detection of small polyps
- Uses X-ray radiation- If polyps or
other abnormalities are found, A COLONOSCOPY
MUST BE PERFORMED- Is not covered by
Medicare or most other insurers as an
initial screening test

Colorectal
Cancer Screening tests covered by Medicare

Not long ago, Medicare started paying for
colonoscopy for people 65 and older. In the
past, Medicare only covered the exam for
people 65 and older at high risk. The
American Cancer Society led the efforts to
expand coverage of this test. People
eligible for Medicare now have more choices
for screening tests.

For people
eligible for Medicare, this is what is
covered:- Stool blood test (FOBT or FIT)
each year for those 50 and over-
Flexible sigmoidoscopy (flex-sig) every four
years for those 50 and over at average risk
- Colonoscopy every two years for those at
high risk- Colonoscopy once every 10
years for those 65 and over at average risk
- Barium enema with air contrast instead if
a doctor believes that it is as good as or
better than flex-sig or colonoscopy-
Virtual colonoscopy is not covered by
Medicare as an initial screen test.

The ASGE recommends talking to your doctor
about screening options. If you are looking
for a qualified physician in your area,
please use our Find a Doctor tool.

For questions about this Web site, contact
info@tummydoctor.org. For questions
specifically related to your health and
getting screened for colorectal cancer,
contact your doctor, or to find a doctor in
your area.